The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Comparison of Clinical Outcomes between ST-Segment Elevation Myocardial Infarction and Non-ST-Segment Elevation Myocardial Infarction in Patients Younger Than 40 Years Who Underwent Percutaneous Coronary Artery Intervention

관상동맥 중재술을 시행 받은 40세 이하의 ST 분절 상승과 비상승 심근경색증 환자의 예후 비교

  • Kim, Nam-Yoon (The Heart Center of Chonnam National University Hospital) ;
  • Park, In-Hyae (Nursing College of Chonnam National Univeristy) ;
  • Jeong, Myung-Ho (The Heart Center of Chonnam National University Hospital) ;
  • Lee, Sook-Ja (Department of Nursing, Chonnam National University Hospital) ;
  • Kim, Dong-Han (The Heart Center of Chonnam National University Hospital) ;
  • Lee, Gi-Hong (The Heart Center of Chonnam National University Hospital) ;
  • Lee, Min-Goo (The Heart Center of Chonnam National University Hospital) ;
  • Sim, Doo-Sun (The Heart Center of Chonnam National University Hospital) ;
  • Park, Keun-Ho (The Heart Center of Chonnam National University Hospital) ;
  • Yoon, Nam-Sik (The Heart Center of Chonnam National University Hospital) ;
  • Yoon, Hyun-Ju (The Heart Center of Chonnam National University Hospital) ;
  • Kim, Kye-Hun (The Heart Center of Chonnam National University Hospital) ;
  • Hong, Young-Joon (The Heart Center of Chonnam National University Hospital) ;
  • Kim, Ju-Han (The Heart Center of Chonnam National University Hospital) ;
  • Ahn, Young-Keun (The Heart Center of Chonnam National University Hospital) ;
  • Cho, Jeong-Gwan (The Heart Center of Chonnam National University Hospital) ;
  • Park, Jong-Chun (The Heart Center of Chonnam National University Hospital) ;
  • Kang, Jung-Chaee (The Heart Center of Chonnam National University Hospital)
  • 김남윤 (전남대학교병원 심장센터) ;
  • 박인혜 (전남대학교 간호대학) ;
  • 정명호 (전남대학교병원 심장센터) ;
  • 이숙자 (전남대학교병원 간호부) ;
  • 김동한 (전남대학교병원 심장센터) ;
  • 이기홍 (전남대학교병원 심장센터) ;
  • 이민구 (전남대학교병원 심장센터) ;
  • 심두선 (전남대학교병원 심장센터) ;
  • 박근호 (전남대학교병원 심장센터) ;
  • 윤남식 (전남대학교병원 심장센터) ;
  • 윤현주 (전남대학교병원 심장센터) ;
  • 김계훈 (전남대학교병원 심장센터) ;
  • 홍영준 (전남대학교병원 심장센터) ;
  • 김주한 (전남대학교병원 심장센터) ;
  • 안영근 (전남대학교병원 심장센터) ;
  • 조정관 (전남대학교병원 심장센터) ;
  • 박종춘 (전남대학교병원 심장센터) ;
  • 강정채 (전남대학교병원 심장센터)
  • Published : 2012.02.01
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Abstract

Background/Aims: The prevalence of coronary artery disease has increased in young adults. We evaluated the differences in clinical characteristics and clinical outcomes in young patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). Methods: A total of 164 patients with acute myocardial infarction who underwent percutaneous coronary intervention were divided into two groups: the STEMI group (120 patients; mean age, 35.7 ${\pm}$ 3.8 years; 118 males) and the NSTEMII group (44 patients; mean age, 35.7 ${\pm}$ 4.3 years; 43 males). We analyzed clinical and angiographic characteristics and major adverse cardiac events (MACE), including death from any cause, non-fatal myocardial infarction, target lesion revascularization, and coronary artery bypass graft surgery, during a 1-year clinical follow-up of the two groups. Results: During hospitalization, Killip class II acute myocardial infarction (5.8% vs. 15.9%, p = 0.041) was observed more frequently in the NSTEMI group. The levels of troponin-I (66.9 ${\pm}$ 103.6 vs. 26.6 ${\pm}$ 38.5 ng/mL, p = 0.014) and N-terminal pro-brain natriuretic peptide (733.0 ${\pm}$ 1,018.1 vs. 476.2 ${\pm}$ 374.5 pg/mL, p = 0.012) were significantly higher in the STEMI group. One-year MACE did not differ between the two groups. By multiple logistic regression analysis, bare metal stents (odds ratio, 3.360; 95% confidence interval, 1.105-10.217; p = 0.033) and high lipoprotein (a) levels (odds ratio, 1.047; 95% confidence interval, 1.020-1.075; p = 0.001) were independent predictors of 1-year MACE. Conclusions: Young patients with STEMI and NSTEMI have similar clinical outcomes. Bare metal stents and high serum lipoprotein (a) levels are independent predictors of MACE during 1-year clinical follow-ups in young patients with acute myocardial infarction.

목적: 최근 흡연의 증가, 식이습관 변화 등 생활양식의 변화로 젊은 연령의 급성 심근경색증 환자가 급격히 증가하고 있는 추세이다. 하지만 젊은 급성 심근경색증 환자의 ST 분절 상승 여부에 따른 장기 예후에 대한 연구가 부족하다. 방법: 급성 심근경색증 진단하에 성공적인 경피적 관상동맥 중재술(percutaneous coronary intervention, PCI)을 시술 받은 40세 이하의 환자 164명을 대상으로 하였다. ST 분절 상승 심근경색증(ST-elevation myocardial infarction, STEMI 120명)과 ST 분절 비상승 심근경색증(non-ST-elevation myocardial infarction, NSTEMI; 44명)로 나누어 두 군 간의 임상적 특징 및 주요 심장사건(사망, 재 경색증, 표적 병변 재개통술, 관상동맥 우회술)을 비교하였다. 결과: ST 분절 상승 심근경색증군에서 ST 분절 비상승 심근경색증군보다 내원 시 troponin-I 수치가 높았으며(66.9 ${\pm}$ 103.6 ng/mL vs. 26.6 ${\pm}$ 38.5 ng/mL, p = 0.014), N-terminal pro-brain natriuretic peptide (733.0 ${\pm}$ 1,018.1 pg/mL vs. 476.2 ${\pm}$ 374.5 pg/mL, p = 0.012)도 높았다. ST 분절 비상승 심근경색증군에서 ST 분절 상승 심근경색증군보다 Killip class II에 해당하는 환자가 많았고(5.8% vs. 15.9%, p = 0.041), 혈청 크레아틴(0.9 ${\pm}$ 0.2 mg/dL vs. 1.3 ${\pm}$ 2.0 mg/dL, p = 0.001)도 높았다. 1년 동안 발생한 주요 심장사건은 두 군 간에 차이는 없었고, 다변량 분석에서 전체 환자의 주요 심장사건을 유의하게 예측하는 인자는 일반금속 스텐트의 삽입(odds ratio 3.360, 95% confidence interval 1.105 to 10.217, p = 0.033), 높은 lipoprotein (a) 수치 (odds ratio 1.047, 95% confidence interval 1.020 to 1.075, p = 0.001) 등이었다. 결론: 40세 이하의 젊은 급성 심근경색증 환자에서 ST 분절 상승 심근경색증과 ST 분절 비상승 심근경색증 환자간 예후는 차이가 없었고, 주요 심장사건에 영향을 미치는 인자로는 일반금속 스텐트 삽입과 혈청 lipotrotein (a) 수치이었다.

Keywords

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